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Birth and death

Wax anatomical plaque showing a foetus, Europe, 1701-1730

Wax anatomical plaque showing a foetus, Europe, 1701-1730

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How has childbirth changed?

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The human life cycle is marked by milestones. The very beginnings of life and its ultimate end are perhaps those culturally afforded the greatest attention. They can also be times of significant medical intervention and management. Over time, attempts to control conception, monitor pregnancy and assist childbirth shifted and blurred our readings of these natural events. The inevitability of death has also challenged its boundaries and, at times, exposed uncertainty about when the living become the dead.

Regulating the beginnings of life

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Men and women have practised contraception for thousands of years. This often opposes religious doctrine or social approval. More proactive measures existed alongside sexual abstinence, ‘coitus interruptus’, amulets and charms. Ancient Chinese, Egyptian, Greek and Roman texts record early birth control methods. These included pessaries, plugs, suppositoriesdouches and potions drunk before or after sex. Certain herbs also induced abortions. This was an acknowledged, if not necessarily approved, method of population control. Such contraception was traditionally a female responsibility. The appearance of the condom, especially from the 1700s, potentially redressed this. However, its early use was mainly for protection against syphilis.

Birth control campaigners and the successes of family planning

Improved contraception during the 1800s became entwined in moral and political debates. Poverty and rapid population growth prompted birth control campaigns. These were associated with eugenics by the early 20th century. Some eugenic advocates proposed involuntary sterilisation of those deemed ‘inferior’.

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There was a gradual liberation of sexual attitudes after the Second World War. The pill, latex condoms and IUDs gave greater control of reproduction. This trend continued with contraceptive implants and injections. The late 20th century could be seen as a period when family planning by the state, as well as by individuals, triumphed. China’s one-child policy is the most extreme example.

The social importance of fertility

Childlessness carries a stigma in many cultures. Fertility rites and religious prayers are still important social rituals.

John Hunter is believed to have supervised the first successful artificial insemination in 1776. However, the revolution in fertility treatment came two centuries later with in vitro fertilisation (IVF). It is the most common technique for assisted reproduction and leads to thousands of births each year. IVF still undergoes intensive research.

Testing for pregnancy and the dilemmas of screening

Pregnancy itself can now be rapidly confirmed with easy to use test-kits, although ancient forms of pregnancy testing have also been recorded. The results could be great news!....or not. Women have long sought various means to rid themselves of an unwanted pregnancies. While controlled abortion is now legal across much of the world, it remains highly controversial.

Such dilemmas may arise during modern antenatal investigations. Birth defects were once a subject of pregnancy myths and superstitions. Screening techniques now check foetuses for physical and genetic conditions. These techniques include ultrasound scanning and invasive methods such as amniocentesis. Along with other forms of genetic screening they raise ethical questions.

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The changing nature of childbirth

Childbirth was once a domestic event. For many it has become highly technical and hospital based. This phenomenon was preceded by a shift in status of those assisting births. Once the domain of female midwives, childbirth became associated with elite medically trained male professionals. The rise of men-midwives in the 1700s symbolised the transition. However, the change was not global. Today the majority of births in the developing world are attended by female traditional birth attendants.

Reducing maternal and infant mortality

Many developments in hospital-based childbirth further reduced maternal and infant mortality. Antisepsis greatly improved matters, but fear of death in childbirth pervaded late Victorian culture. The early decades of the 20th century saw improved prenatal care and a combination of anaesthetics, blood transfusions and latterly antibiotics reduce death rates.

Extending the limits of life... for some

As rates of death in childbirth decrease, medical advances increase the span of life. They save premature babies and prolong the lives of the elderly. As life is extended, death can seem remote. Formerly killer diseases are tamed by vaccines, drugs or improved public health. Mass death is mainly restricted to wars, natural disasters and accidents.

However, early mortality remains common in many parts of the world. Millions of these deaths are from preventable causes. Perceptions and experiences of death depend on when and where you live. Average life expectancy in Britain nears 80, but for much of Africa it is well under 50.

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Ethical quandaries in life and death

Postponing death raises moral questions. Treating progressive, chronic illnesses may prolong life, but sometimes to the point where it is intolerable. The legal status of euthanasia, and access to it, are major issues today. The redefining of death in neurological terms in the late 1960s has also raised difficult ethical issues. These include the ambiguities of interpreting brain death, and switching off the life support machine of a patient whose heart still beats.

The preparation and final disposal of a body following death were historically idealised as times of commemoration, mourning and remembrance. These events are associated with religion, ritual and an afterlife.

In most cultures the dead are revered, in some cultures they are even worshipped. They are buried in designated areas with their names engraved on memorials. In some cultures their bodies might even be artificially preserved.

How the dead continue to help the living

Dissection and anatomical study have been basic tools of medical teaching. Autopsies provide information about disease and injury that would be unattainable by other means. The dead are vital to medical research in the laboratory. Bodies provided for an expanding range of organ transplants and transplants of other tissues and body parts as the 20th century progressed. Harvesting from bodies is now done at a cellular and genetic level. In a curious meeting between the dead and the living, the former are increasingly being called on to prolong the lives of the latter.

Bibliography

P K Wilson, A Dally and C B King (eds), Childbirth: Changing Ideas and Practices in Britain and America 1600 to the Present (New York: Garland, 1996)

R Jütte, Contraception: A History (Cambridge: Polity Press, 2007)

A McLaren, A History of Contraception: From Antiquity to the Present Day (Oxford: Blackwell, 1990)

J Donnison, Midwives and Medical Men: A History of the Struggle for the Control of Childbirth (London: Historical Publications, 1988)

C Hanson, A Cultural History of Pregnancy: Pregnancy, Medicine, and Culture (Basingstoke: Palgrave Macmillan, 2004)

S J Youngner, R M Arnold and R Schapiro (eds), The Definition of Death: Contemporary Controversies (Baltimore, MD: Johns Hopkins University Press, 1999)

A Kellehear, A Social History of Dying (Cambridge: CUP, 2007)

A Robben (ed.), Death, Mourning, and Burial: A Cross-Cultural Reader (Oxford: Wiley-Blackwell, 2005)

M Kerrigan, The History of Death: Burial Customs and Funeral Rites, from the Ancient World to Modern Times (Lyons Press, 2007)

Glossary:

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